Top

Published in:

01-02-2019 | Original Contributions

Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy

Authors: Michael J. Cammarata, Rami S. Kantar, William J. Rifkin, Jason A. Greenfield, Jamie P. Levine, Daniel J. Ceradini

Published in: Obesity Surgery | Issue 2/2019

Abstract

Background

Widespread adoption of bariatric surgery in the treatment of obesity has led to greater numbers of patients seeking panniculectomy, including aged patients, who represent a rapidly growing proportion of the U.S population. Although the quality of life and functional benefits of abdominal panniculectomy have been established, its safety in patients 65 years and older has not been evaluated.

Methods

The American College of Surgeons National Surgical Quality Improvements (ACS-NSQIP) database was used to identify patients undergoing panniculectomy between 2010 and 2015. Age 65 years and older was the risk factor of interest, and primary outcomes included 30-day wound complications, overall complications, reoperation, readmission, and mortality. Multivariate regression was performed to control for confounders.

Results

Review of the database identified 7030 patients who underwent abdominal panniculectomy. When stratified by age, 6455 (91.8%) of patients were younger than 65, and 575 (8.2%) were 65 or older. Multivariate regression analysis demonstrated that age over 65 was a significant independent risk factor for wound complications (OR = 1.81; 95% CI 1.35–2.42; p < 0.001) and all complications (OR = 1.46; 95% CI 1.15–1.87; p = 0.002). BMI, smoking, diabetes, and partial or total dependence were also identified as significant independent risk factors for wound and all complications.

Conclusion

Our analysis demonstrates that advanced age is an independent risk factor for wound and overall complications following abdominal panniculectomy. These results highlight the importance of preoperative evaluation and optimization of modifiable preoperative risk factors as well as close postoperative follow-up for safe outcomes in patients 65 and older.

Gu JK, Charles LE, Bang KM, et al. Prevalence of obesity by occupation among US workers: the National Health Interview Survey 2004–2011. J Occup Environ Med. 2014;56(5):516–28. https://doi.org/10.1097/JOM.0000000000000133.CrossRefPubMedPubMedCentral

Almutairi K, Gusenoff JA, Rubin JP. Body contouring. Plast Reconstr Surg. 2016;137(3):586e–602e. https://doi.org/10.1097/PRS.0000000000002140.CrossRefPubMed

Gallagher S, Gates JL. Obesity, panniculitis, panniculectomy, and wound care: understanding the challenges. J Wound Ostomy Continence Nurs. 2003;30(6):334–41. https://doi.org/10.1016/S1071.CrossRefPubMed

Jotwani P, Srivastav V, Tripathi M, et al. Free-access open-source e-learning in comprehensive neurosurgery skills training. Neurol India. 2014;62(4):352–61. https://doi.org/10.4103/0028-3886.141208.CrossRefPubMed

Potter JF, Burton JR, Drach GW, et al. Geriatrics for residents in the surgical and medical specialties: implementation of curricula and training experiences. J Am Geriatr Soc. 2005;53(3):511–5. https://doi.org/10.1111/j.1532-5415.2005.53173.x.CrossRefPubMed

Dasgupta M, Rolfson DB, Stolee P, et al. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48(1):78–83. https://doi.org/10.1016/j.archger.2007.10.007.CrossRefPubMed

Watt J, Tricco AC, Talbot-Hamon C, et al. Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis. BMC Med. 2018;16(1):2. https://doi.org/10.1186/s12916-017-0986-2.CrossRefPubMedPubMedCentral

Colloca G, Santoro M, Gambassi G. Age-related physiologic changes and perioperative management of elderly patients. Surg Oncol. 2010;19(3):124–30. https://doi.org/10.1016/j.suronc.2009.11.011.CrossRefPubMed

Tang B, Green C, Yeoh AC, et al. Post-operative outcomes in older patients: a single-centre observational study. ANZ J Surg. 2018;88(5):421–7. https://doi.org/10.1111/ans.14433.CrossRefPubMed

10.

Matsuo M, Yamagami T, Higuchi A. Impact of age on postoperative complication rates among elderly patients with hip fracture: a retrospective matched study. J Anesth. 2018;32(3):452–6. https://doi.org/10.1007/s00540-018-2494-8.CrossRefPubMed

11.

Gerber P, Anderin C, Szabo E, et al. Impact of age on risk of complications after gastric bypass: a cohort study from the Scandinavian obesity surgery registry (SOReg). Surg Obes Relat Dis. 2018;14(4):437–42. https://doi.org/10.1016/j.soard.2017.12.024.CrossRefPubMed

12.

Pereira JF, Golijanin D, Pareek G, et al. The association of age with perioperative morbidity and mortality among men undergoing radical prostatectomy. Urol Oncol. 2018;36(4):157 e7–e13. https://doi.org/10.1016/j.urolonc.2017.11.019.CrossRef

13.

Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults. Eff Clin Pract. 2001;4(4):172–7.PubMed

14.

Arthurs ZM, Cuadrado D, Sohn V, et al. Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg. 2007;193(5):567–70; discussion 70. https://doi.org/10.1016/j.amjsurg.2007.01.006.CrossRefPubMed

15.

Derickson M, Phillips C, Barron M, et al. Panniculectomy after bariatric surgical weight loss: analysis of complications and modifiable risk factors. Am J Surg. 2018;215(5):887–90. https://doi.org/10.1016/j.amjsurg.2018.02.008.CrossRefPubMed

16.

Barcha CP, Ranzer MJ. Smoking as a risk factor for panniculectomy: an analysis of 7650 cases. J Plast Reconstr Aesthet Surg. 2018;71(5):767–9. https://doi.org/10.1016/j.bjps.2017.12.014.CrossRefPubMed

17.

Mioton LM, Buck 2nd DW, Gart MS, et al. A multivariate regression analysis of panniculectomy outcomes: does plastic surgery training matter? Plast Reconstr Surg. 2013;131(4):604e–12e. https://doi.org/10.1097/PRS.0b013e3182818f1f.CrossRefPubMed

18.

Couto RA, Lamaris GA, Baker TA, et al. Age as a risk factor in abdominoplasty. Aesthet Surg J. 2017;37(5):550–6. https://doi.org/10.1093/asj/sjw227.CrossRefPubMed

19.

Massenburg BB, Sanati-Mehrizy P, Jablonka EM, et al. Risk factors for readmission and adverse outcomes in abdominoplasty. Plast Reconstr Surg. 2015;136(5):968–77. https://doi.org/10.1097/PRS.0000000000001680.CrossRefPubMed

20.

Winocour J, Gupta V, Ramirez JR, et al. Abdominoplasty: risk factors, complication rates, and safety of combined procedures. Plast Reconstr Surg. 2015;136(5):597e–606e. https://doi.org/10.1097/PRS.0000000000001700.CrossRefPubMed

21.

Yeslev M, Gupta V, Winocour J, et al. Safety of cosmetic procedures in elderly and octogenarian patients. Aesthet Surg J. 2015;35(7):864–73. https://doi.org/10.1093/asj/sjv053.CrossRefPubMed

22.

The American College of Surgeons. The American College of Surgeons National Surgical Quality Improvement Program. 2015. https://www.facs.org/quality-programs/acs-nsqip/about. Accessed 1 June 2018.

23.

Chow WB, Rosenthal RA, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453–66. https://doi.org/10.1016/j.jamcollsurg.2012.06.017.CrossRefPubMed

24.

Beard J, Officer A, Cassels A. World Report on Ageing and Health. Ageing and life-course, World Health Organization: 2015. 260. http://www.who.int/ageing/events/world-report-2015-launch/en/. Accessed 1 June 2018.

25.

Herman CK, Hoschander AS, Wong A. Post-bariatric body contouring. Aesthet Surg J. 2015;35(6):672–87. https://doi.org/10.1093/asj/sjv008.CrossRefPubMed

26.

Acarturk TO, Wachtman G, Heil B, et al. Panniculectomy as an adjuvant to bariatric surgery. Ann Plast Surg. 2004;53(4):360–6. discussion 7CrossRef

27.

Davis MM, Slish K, Chao C, et al. National trends in bariatric surgery, 1996-2002. Arch Surg. 2006;141(1):71–4; discussion 5. https://doi.org/10.1001/archsurg.141.1.71.CrossRefPubMed

28.

Borud LJ, Warren AG. Body contouring in the postbariatric surgery patient. J Am Coll Surg. 2006;203(1):82–93. https://doi.org/10.1016/j.jamcollsurg.2006.01.015.CrossRefPubMed

29.

Mitchell JE, Crosby RD, Ertelt TW, et al. The desire for body contouring surgery after bariatric surgery. Obes Surg. 2008;18(10):1308–12. https://doi.org/10.1007/s11695-008-9557-0.CrossRefPubMed

30.

Kitzinger HB, Abayev S, Pittermann A, et al. The prevalence of body contouring surgery after gastric bypass surgery. Obes Surg. 2012;22(1):8–12. https://doi.org/10.1007/s11695-011-0459-1.CrossRefPubMed

31.

Leahy PJ, Shorten SM, Lawrence WT. Maximizing the aesthetic result in panniculectomy after massive weight loss. Plast Reconstr Surg. 2008;122(4):1214–24. https://doi.org/10.1097/PRS.0b013e31818459ca.CrossRefPubMed

32.

Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9. https://doi.org/10.1016/j.arr.2011.03.003.CrossRefPubMed

33.

St Sauver JL, Boyd CM, Grossardt BR, et al. Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open. 2015;5(2):e006413. https://doi.org/10.1136/bmjopen-2014-006413.CrossRefPubMedPubMedCentral

34.

Kantar RS RW, Wilson SC, David JA, Diaz-Siso JR, Levine JP, Golas AR, Ceradini DJ. Abdominal panniculectomy: determining the impact of diabetes on complications and risk factors for adverse events. Plast Reconst Surg. 2018. https://doi.org/10.1097/PRS.0000000000004732.

35.

Shermak MA, Rotellini-Coltvet LA, Chang D. Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies. Plast Reconstr Surg. 2008;122(1):280–8. https://doi.org/10.1097/PRS.0b013e31817742a9.CrossRefPubMed

36.

Pluvy I, Garrido I, Pauchot J, et al. Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations. Ann Chir Plast Esthet. 2015;60(1):e3–e13. https://doi.org/10.1016/j.anplas.2014.06.011.CrossRefPubMed

37.

Constantine RS, Davis KE, Kenkel JM. The effect of massive weight loss status, amount of weight loss, and method of weight loss on body contouring outcomes. Aesthet Surg J. 2014;34(4):578–83. https://doi.org/10.1177/1090820X14528208.CrossRefPubMed

38.

Albino FP, Koltz PF, Gusenoff JA. A comparative analysis and systematic review of the wound-healing milieu: implications for body contouring after massive weight loss. Plast Reconstr Surg. 2009;124(5):1675–82. https://doi.org/10.1097/PRS.0b013e3181b98bb4.CrossRefPubMed

39.

Das S, Forrest K, Howell S. General anaesthesia in elderly patients with cardiovascular disorders: choice of anaesthetic agent. Drugs Aging. 2010;27(4):265–82. https://doi.org/10.2165/11534990-000000000-00000.CrossRefPubMed

40.

Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396–407. https://doi.org/10.1016/S0140-6736(11)61381-0.CrossRefPubMed

41.

Wu WC, Schifftner TL, Henderson WG, et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA. 2007;297(22):2481–8. https://doi.org/10.1001/jama.297.22.2481.CrossRefPubMed

42.

Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865–77. https://doi.org/10.1016/j.jamcollsurg.2006.08.026.CrossRef

43.

Zavlin D, Jubbal KT, Balinger CL, et al. Impact of metabolic syndrome on the morbidity and mortality of patients undergoing panniculectomy. Aesthet Plast Surg. 2017;41(6):1400–7. https://doi.org/10.1007/s00266-017-0952-6.CrossRef

44.

Sgonc R, Gruber J. Age-related aspects of cutaneous wound healing: a mini-review. Gerontology. 2013;59(2):159–64. https://doi.org/10.1159/000342344.CrossRefPubMed

45.

Greenhalgh DG. Management of the skin and soft tissue in the geriatric surgical patient. Surg Clin North Am. 2015;95(1):103–14. https://doi.org/10.1016/j.suc.2014.09.008.CrossRefPubMed

46.

Pestana IA, Campbell D, Fearmonti RM, et al. “Supersize” panniculectomy: indications, technique, and results. Ann Plast Surg. 2014;73(4):416–21. https://doi.org/10.1097/SAP.0b013e31827f5496.CrossRefPubMed

47.

Staalesen T, Elander A, Strandell A, et al. A systematic review of outcomes of abdominoplasty. J Plast Surg Hand Surg. 2012;46(3–4):139–44. https://doi.org/10.3109/2000656X.2012.683794.CrossRefPubMed

48.

Ardehali B, Fiorentino F. A meta-analysis of the effects of abdominoplasty modifications on the incidence of postoperative seroma. Aesthet Surg J. 2017;37(10):1136–43. https://doi.org/10.1093/asj/sjx051.CrossRefPubMed

49.

Manahan MA, Shermak MA. Massive panniculectomy after massive weight loss. Plast Reconstr Surg. 2006;117(7):2191–7; discussion 8-9. https://doi.org/10.1097/01.prs.0000218174.89832.78.CrossRefPubMed

Title: Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy
Authors: Michael J. Cammarata
Rami S. Kantar
William J. Rifkin
Jason A. Greenfield
Jamie P. Levine
Daniel J. Ceradini
Publication date: 01-02-2019
Publisher: Springer US
Published in: Obesity Surgery / Issue 2/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-018-3492-5

At a glance: The STEP trials

Springer Medicine

Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2019

Impact of Patient Attrition from Bariatric Surgery Practice on Clinical Outcomes

Invited Response Letter to the Letter “Our Experience Regarding the Association between Gastrointestinal Stromal Tumor and Bariatric Surgery. A Response to a Letter “Gastrointestinal Stromal Tumor After Laparoscopic Sleeve Gastrectomy: Be Awake Before, During, and After a Bariatric Procedure”

Alterations of Gastric Emptying Features Following Laparoscopic Sleeve Gastrectomy in Chinese Patients with Obesity: a Self-Controlled Observational Study

Lithium Toxicity with Severe Bradycardia Post Sleeve Gastrectomy: a Case Report and Review of the Literature

Effect of Trocar Site Bupivacaine Administration, Time of First Passage of Flatus, and Duration of the Surgery on Postoperative Pain After Sleeve Gastrectomy: a Case Control Study

A Higher Preoperative Glycemic Profile Is Associated with Rapid Gastric Emptying After Sleeve Gastrectomy for Obese Subjects